Healthcare Provider Details

I. General information

NPI: 1003375023
Provider Name (Legal Business Name): CENTER FOR NETWORK THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GIBSON PL STE 103
FREEHOLD NJ
07728-4837
US

IV. Provider business mailing address

333 CEDAR AVE STE 3
MIDDLESEX NJ
08846-2400
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-5800
  • Fax: 732-431-5806
Mailing address:
  • Phone: 732-560-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KUMAR CIDAMBI
Title or Position: CEO
Credential:
Phone: 732-560-1080